title: The effects of sacral nerve stimulation on continence are temporarily maintained after turning the stimulator off.
abstract: OBJECTIVE
  Sacral nerve stimulation is an effective treatment for urinary and faecal incontinence even though its mechanism of action is uncertain. Central nervous system involvement by 'setting-up' neurological mechanisms appointed to control pelvic function has been hypothesized. The study aimed to evaluate whether the effects of long-term sacral nerve stimulation are memorized and therefore maintained after switching off the stimulator.
  
  
  METHODS
  Patients having sacral nerve stimulation for faecal and/or urinary incontinence for at least 1 year had the stimulator turned off and the results monitored. Data recorded with the stimulator off were compared with post-implant data. If symptoms recurred the stimulator was switched back on. Nineteen patients entered the study. Fourteen had faecal and/or urinary incontinence and five had faecal incontinence alone. The symptoms were assessed by means of a bowel function diary and dedicated questionnaire.
  
  
  RESULTS
  In 10 patients symptoms recurred at different intervals after a median off period of 3.4 months with a probability of symptom relapse of 55%. The Fecal Incontinence Quality of Life (FIQL) score did not show any significant difference in nine patients with the stimulator off for at least 1 year. No factors predictive of symptom recurrence were identified although an idiopathic aetiology, severity of disease and urinary incontinence had higher hazard ratios. During the off period, none of the scores and episodes of incontinence showed significant changes compared with the on period.
  
  
  CONCLUSIONS
  The effects of sacral nerve stimulation on faecal and urinary incontinence were maintained in about half of patients after switching the stimulator off, but in some symptoms returned after different periods of time. The data shed new light on possible effects of sacral nerve stimulation on brain neuroplasticity in the control of continence.
authors.affiliation: Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
authors.forename: I
authors.initials: I
authors.lastname: Giannini
authors.forename: S
authors.initials: S
authors.lastname: Giuratrabocchetta
authors.forename: R
authors.initials: R
authors.lastname: Digennaro
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation* / Q000503:physiopathology; D015331:Cohort Studies; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005242:Fecal Incontinence / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000150:complications / Q000628:therapy*
keywords: Sacral nerve stimulation; brain neuroplasticity; faecal incontinence; urinary incontinence